cS ere ere et Pee aD as, | Waishali:Bihar- yee e - rH oe eg ee in i eet ne erway) i‘ eee Meena an ermine | Pisce Corre ree a itt (Afiliated to NCHMCT. Sector 62, NOIDA) \PPLICATION FORM FOR FILLING OF RESIDUAL SEATS FOR ADMISSION TO 3 YEAR B So. in H & HA OURSE FOR THE SESSION (2024-22) Course Applied For:1. 3 Year B.SC. in H & HA Course 2. 2 Years M. Se. in H & HA (ek [7] .onyourcholee, oD} 2 3) 4) 5 n 9) Name of applicant: Father's Name: (seperSecrreay Corea) Mothers Name: (asperSecordoy Catt) Permanent Address: Category (SCISTIOBCIUR): sc st ope uR| euso (Pesto Date of ith: (eeperinte ary Sel Cai ty or (bay v Wea ‘Age asion 1* July 2021: (eas) (Months). (Days) Maris obtained in 10+2 or equivalent examination: SNe) Exam Name ofBoard | — Wax. | Marke | —%iof | —Yearat Marks | Obtained | Marks | Passing 70th Zz [iz Enclosed attested copies ofestmonials: 10" 10%2 or equivalent Category certficate (seannedcopes) (pease tick) ‘Affirmation / Declaration ‘That above particulars are tue tothe best of my knowiedge and belief | wil submit proof ofthe same on the date of physical reporting tthe Insitute Date: Place: Mobile